Saturday, August 25, 2012

The End (and the beginning) are here. The end of summer is upon us, the beginning of my last semester of nursing school is about to begin. It is also the beginning of our daughter's 7th grade year. It's going to be a chaotic 16 weeks. Hmmmm, what have we been up to lately ....

I worked pretty much straight out in the beginning of August. Between EMS and the ER, I've been on duty more than I've been anything else. We did get a chance to go camping one more time before our daughter returned from Grandma's house out of state. I spent a day on the road with a friend of mine to meet her return flight at the airport. We went out to lunch, to a farmer's market, and the mall prior to meeting the flight. It was a great day ... with a lot of driving.

A few days later, we went on a family camping trip to a private beach on a lake. Private in the aspect it's a public camping spot, but first dibs gets the use of it and you have to get there by boat. There are a lot of other beaches on the lake that are not private and a few other private ones. We lucked out with weather and it was amazing. No cell phone service either. Did some fishing, some reading, and lots of swimming. It was the first time my husband and daughter had been there, I had gone in high school. We will definitely be making a return trip next year.

Last night, I took our daughter to the county fair since my husband was working. She had a bracelet for the rides and met up with some school friends. They were IN-SANE. They went on everything that I never went on even when I was younger. Small county fair = small lines, even on a Friday night. They got off the ride, and got right back in line. She felt great and was having a blast ... till the adrenaline wore off on the way home and she started feeling SICK. A warm shower and sips on some fluids made her feel better. "I have no regrets, I just don't feel well right now." She probably will jump at the chance to do it all over again ... next year.

School starts for her the last Wednesday of the month, 1 week ahead of me. My first Partnership shift will be September 10th. Some of the class materials have been posted, but not all of them. So far, I have couple short papers to write and 3 exams ahead of me. "I think I can, I think I can, I think I can."

Wednesday, August 8, 2012

On August 6th, my Great Grandmother passed away peacefully at a nursing home. I have mixed emotions about this WHOLE situation.

First, the last time I saw my Great Grandmother, dementia had set in and she did not recognize me. I look a lot like my mother, so she tried ... but it was heartbreaking. I had never been in the shoes of a person who has a relative with dementia/early Alzheimer's. That day, I understood.

Second, she's been declining for a while. She had been living in another state in an assisted apartment close to one of her grand daughters. Unbeknownst to me, she went to the hospital months ago and was discharged to a long term care facility due to her lack of ability to care for herself. Hmm, I would have liked to been told that.

Third, a text message that said, "The nursing home gave [Grammie] morphine tonight," while I was at work (and not having known the rest) was a shock to the system. I immediately dialed my mother, hung up, called back when I got voicemail, and she called me at the same time to explain. That's when I was filled in on recent events.

Fourth, apparently the long term care doctor initiated palliative care orders without discussing anything with the local family (any family, actually). I'm grateful for the palliative care orders ... but I honestly didn't think initiating them that way was standard practice.

Fifth, again I'm grateful the nursing staff followed the orders and made Grammie comfortable. Some nurses are afraid to give narcotic medications in end of life care. Narcotics cause respiratory depression (slowed breathing) which some nurses feel is what essentially "kills" the patient instead of letting them go naturally. In this situation, though, the nursing staff dosed her THEN called family saying she won't make it through the night. Hmm, calling prior to would have given at least a little more time for family to wrap their minds around the concept and get there.

Sixth, not even an hour later, my text message said, "She passed away." Just like that. Granted, text messages are convenient for when I'm working ... but I just sat there and stared at my phone. I had felt it vibrate in my pocket and I walked away from my desk to look at it.

I deal with death and dying practically every day. Heck, just on Sunday 20 minutes prior to the end of my shift, we were coding (CPR, IV drugs, etc) a person. Fifteen minutes after it had begun, his family was wracked with sobs in the hallway when time of death was declared. On the evening Grammie passed away, a couple hours after that last text message, we were emergently treating and transferring a patient with a STEMI (heart attack) to a heart center hospital in our same town. The transfer and treatment they received at that facility could stop the damage to the person's heart and possibly "save" them from dying. I have completed post mortem care on numerable patients throughout my career as a CNA, all with dignity and respect. There is a level of detachment that makes it possible to complete such tasks. Yet, on August 6th, I sat there and stared at my phone. I hadn't seen her prior to dementia for at least 3 years. Yet, I sat there and stared at my phone.

I was kind of glad for work after that. It gave me a distraction. One of my best friends was working, though, and he automatically asked me what was wrong. I was "not being myself." I made him choke when I said, "I was fine until my great grandmother just died." His face just contorted and he stared at me for a moment. He ended up staying an extra hour and a half, off the clock, kind of lingering - finding reasons to continue to chat with myself or others near me. I suspected his delay in leaving was because of me, but I wasn't sure until he confirmed it later on. He said simply, "I was worried about you." He was supposed to work tonight, but his schedule was changed last minute. It would have been nice to have him to talk with.

After it all, I know that Grammie is in a better place. She is now comfortable and no longer in pain. It's just the overwhelming feeling of loss that no previously ingrained ability to detach myself will help heal. I can only look back on the memories of many lunches spent at The Chicken Coop restaurant, her love of Reuben sandwiches, and her "best" china on display in my china cabinet. Someday, I'll actually have to host a dinner with that china. She always wanted it to be used, but she never had the occasion (always used her "everyday" china) and I haven't yet. Maybe it's time to remedy that.